By Howard J. Bennett, MD
Pediatric offices are warm and colorful to make them an inviting place for children. However, despite the friendly atmosphere, doctors’ offices can be unsettling for children. One minute they may be having a grand time in the waiting room. Then, with little or no warning, they are whisked back to the examination area where they are undressed, weighed and measured, and examined by the doctor. To top this off, the visit often ends with blood tests or shots.
When children see the doctor, they often feel a loss of control. Children may not understand why they are being examined, the doctor’s instruments can be frightening (or cold), and they typically have little say in the matter.
How You Can Help
There are a number of things you can do to make doctor’s appointments less stressful for your child. The way you talk about the visit is important. Children are sensitive to their parent’s emotional state, so a calm and reassuring tone on your part helps tremendously. Let your child know that she is seeing the doctor before you leave for the appointment. This will give her a chance to ask questions about what to expect. If your child appears anxious, discuss a previous visit, emphasizing what she liked about the doctor or the office.
The most important thing to do at a doctor’s visit is to tell your child the truth. Above all, avoid the temptation to say something will not hurt. The reason for this is because “the truth” varies from person to person. For example, even though throat cultures do not bother most adults, they can be very distressing to children. It is better to say that a procedure may hurt, but add that it will be over quickly and you will be there to help.
Plan Your Trip
Getting to a doctor’s appointment in one piece can be tricky, especially if you were up the night before. It is helpful, therefore, if you plan your day carefully. Here are some tips to keep in mind.
• If possible, do not schedule a visit during your child’s naptime. This makes children cranky and harder to examine.
• Bring a bottle or snack to the office in case your child gets hungry.
• Do not plan another activity right after the visit because your appointment may last longer than anticipated. If this happens and you feel pressure to be somewhere else, your stress will add to your child’s anxiety.
• Doctors are sometimes late, so plan on spending time in the waiting room. Although pediatric offices have an abundance of books and magazines, take along a favorite book or toy in case your child gets irritable.
• Bring as few children to the office as possible. The more kids in tow, the more difficult it will be for you to help your child and pay attention to what the doctor has to say.
Help Your Child Interact With the Doctor
Although pediatricians and family practitioners love children, the opposite is not always true. That being said, there are a number of things you can do to make the visit go more smoothly.
• If you are new to an area, make a “get acquainted” visit with the doctor. These are brief visits, often scheduled during lunch, where the doctor can meet you and your child in an informal way that does not involve an examination.
• The first time you see a new doctor, ask that your child does not get a shot or blood test. This will make his initial experience with the doctor a positive one. Offer to come back for a follow-up visit if the tests are required for school.
• If your child is nervous before the appointment, read a book about visiting the doctor or have a play session where your child gets to be the doctor—his “patient” can be you or one of his toys.
• Bring a love object to the appointment. Stuffed animals are not only comforting, but they foster communication between doctor and child.
• Bring a toy doctor’s kit so your child can “examine” the doctor.
• Bring a favorite joke or riddle that your child can share with the doctor.
• Encourage your child to draw a picture for the doctor. This is a nice gesture that opens the stage for positive interactions between doctor and child.
• Doctors sometimes spend more time talking to parents than children. If this happens, try to redirect the conversation so your child can be involved in the visit.
• Doctor’s sometimes use jargon or words that can frighten or confuse children. If this happens, ask the doctor to use simpler terms or have your child go to the waiting room.
What To Say About Shots
Parents often ask if they should tell children about shots before the appointment. The answer to this question depends on the nature of the visit. If your child has a specific appointment for a shot, you should tell him before you leave home. Although this may make your child anxious, it gives him a chance to mentally prepare for the procedure.
If your child is having a checkup, the best approach is to say you do not know if he is getting a shot. The reason for this advice is because immunization recommendations change. Therefore, it is hard to know for sure if a shot will be part of the visit. Even in circumstances where shots are the norm, i.e., the booster shots that accompany 4-year-old checkups, doctors sometimes run out of vaccines or your child may have a problem that precludes getting the shot. In that instance, he would have needlessly worried about the shot.
In my practice, I tell children the examination comes first and then I will let them know if they need a shot. (I used the same approach my book, “Lions Aren’t Scared of Shots.”) I do this because it allows us to focus on the first part of the visit. If a child knows he needs a shot at the beginning of the checkup, he will repeatedly ask when the shot is coming and whether it will hurt. This not only sours the visit, but it is not the best time to reassure them.
Helping Your Child With Shots and Blood Tests
A recent study examined which techniques are most effective in helping young children cope with the pain of shots and other medical procedures. According to the report, distraction was one of the most effective tools to help children deal with needle-related pain. Older children also had success by giving themselves positive messages that they could handle the pain. For example, “I can do this,” “I’m brave,” or “This will be over soon.”
Techniques To Use Before the Shot
Once a child knows he is getting a shot, he will begin asking questions about when it is coming and what it will feel like. As mentioned previously, a calm and direct approach works best. It also helps to give children some choices. Your child can choose which arm gets the shot, which bandage to use, and whether you should rub the arm fast or slow when the injection is over.
We have a policy in my office called “tag-team shots.” If a child needs more than one immunization, two of our nurses administer the shots simultaneously. This reduces the anticipatory anxiety of getting a second shot, and two nurses do a better job distracting the child than one. Here are some additional techniques that can help reduce shot stress.
• Young infants: maintain eye contact, smile and talk to the baby, sing songs.
• Older infants and toddlers: distract the child with toys, songs, a story, car keys, blowing bubbles, finger puppets or looking at interesting objects in the room.
• Preschoolers and school-aged children: same as toddlers plus look at family pictures, use electronic devices like a cell phone, talk to the child right before the shot or watch a video on a portable DVD player.
For older children who are very anxious about needles, you can request a topical anesthetic to reduce the pain. This is more effective for blood tests than shots and takes 30 to 45 minutes to work.
What To Do If Your Child Won’t Cooperate
Some children are unable to cooperate with shots or blood tests no matter what you do. In such cases, a child may attempt to run out of the office or struggle when someone tries to give him the shot. If this happens to you, it is important to realize that fear is motivating your child. Never tell your child he is being a baby because this does not work and only makes him feel worse.
Sometimes children stall instead of getting upset and ask over and over what the shot will feel like or they may say “Just give me one more minute, and I’ll be ready.” In many cases, this minute never ends and the process can go on for a long time with no end in sight.
There is a fine line, therefore, between giving a child a chance to voice his concerns and letting his fears or stalling go on forever. You should trust your instincts if you think you could convince your child to cooperate with a procedure because this is best for everyone; however, there comes a time when your child needs you to be strong for him. In this instance, it may be best to hold the child for a procedure so the stress will end. This should be done calmly and without anger. You can say something like, “I can see that you’re very upset, so mommy is going to hold you to keep you from hurting yourself when you get the shot.” Do not be embarrassed if you are unable hold your child. This happens to lots of parents in which case a nurse can do it for you.
Techniques To Use After the Shot
Although it is a worthwhile goal to reduce the stress of medical procedures, some children will cry despite your attempts to ease their pain. This is normal. I always tell children that it is okay to cry, but we need to make sure they hold still. Once the shot is over you can tell your child that he did a good job getting through the procedure. Other things that help include hugs and kisses, stickers, and lollipops. Finally, it may help if your child knows he can do something special after the visit such as a trip to the park or getting some extra TV/computer time.
© 2012 Howard J. Bennett. All Rights Reserved.
(First published in Westchester Parent December 2007.)
For more articles and other information,
please visit Dr. B’s website at http://www.howardjbennett.com